P - 80723_ � ,� ...
� REQUEST FOR ELECTRICAL INSPECTION
������ O � in821eUni essty A earRm. S- 28,1St. Paul, MN 55104
Phone (612) 642-0800 "�'
Home Duplex Apt. B1dg. Other: New Ad
Commercial Industrial Farm Remod e ai
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enfer remarks in this space and on the back of ihe white copy only.
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Colculate Inspection Fee - This Inspection Request will not be accep�ithout the correct fee: `c�.. �3 a
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO L
Sign/Outline Ltg. Xfmr. """"'
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins the eleclrical inswllalion dexribed herein on the dates stated
Irrigation Boom Rougf�ln Dare
Speciallnspecti „
Final D
lnvestigative Fee C �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void I B months from vakdotion date printed in this box.
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PLEASE PRINT OR TYPE
Request Daf=� � Rough-in inspection required$ ❑ Yes No InspecKon O�er Than RougMn: ❑ Ready Now 0 Will Call
� (You musf call fhe inspecfor when ready) Date Ready:
I, .�licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Addreu (Street, Box, or Route No.) Ciy Zip Code .
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Section No. Township Name or No. Ranae . Fire No. CounN
Occupant • Phone No.
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Power Suoolier A re
Electrical Conhacror �Company ame� Conhnctor License No. Master Lic. No.
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Mailing Address (Confractor or P rming Instailaf n)
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orOwnerPerfocmi�gTostallation� -� ' P No. ��'
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY